Healthcare Provider Details

I. General information

NPI: 1467606079
Provider Name (Legal Business Name): THINZAR AUNG HTUT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MYAT THINZAR AUNG MD

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S GRAND AVENUE SUITE 101
LOS ANGELES CA
90015
US

IV. Provider business mailing address

22909 FERN AVE
TORRANCE CA
90505-2935
US

V. Phone/Fax

Practice location:
  • Phone: 310-345-1610
  • Fax:
Mailing address:
  • Phone: 310-345-1610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA105297
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: